MIPS APMs In The Quality Payment Program

Launched in 2017 to reward high-value clinicians with upward reimbursement adjustments and penalize low-value clinicians with downward adjustments, the nationwide Medicare Quality Payment Program (QPP) consists of two potential participation tracks: the Merit-based Incentive Payment System (MIPS) and the Advanced Alternative Payment Model (AAPM). In recent posts, we detailed how strong performance in the MIPS track may not lead to the frequently referenced maximum reimbursement increases (for example, ±4 percent in 2017 and ±5 percent in 2018) and implications for clinicians. Instead, actual increases could potentially exceed or fall below those amounts due to how Medicare funds adjustments and how clinicians’ performance relative to others impacts their MIPS scoring.

A related and equally important issue for clinicians is to understand AAPM participation as an alternative that may exempt them from MIPS. An alternative payment model (APM) qualifies as being “advanced” if participating clinicians bear downside financial risk and are measured on their quality performance…